The Doctrine of Double Effect (DDE) and the Doctrine of Doing and Allowing (DDA) both identify an agent’s method of contribution to a harmful consequence as being relevant in assessing the permissibility of the individual’s actions. In this paper, I shall first outline the DDE and DDA. I will then apply these doctrines to explain the permissibility of one’s actions in Thomson’s case of the ‘violinist’, and subsequently to a variant case of the ‘violinist’. Next, I shall reconstruct two separate cases of abortion and explain how the DDE and DDA can be applied to these scenarios.
Finally, I shall critique the applicability of the DDE and DDA by utilizing Kamm’s argument that allowing to die is morally equivalent to killing in cases of abortion.
The DDE is a set of ethical principles, which predicate the existence of a morally relevant difference between what one foresees and what one intends as a result of their actions.
Specifically, the DDE states that it is morally worse to inflict a harm that is intentional, than it is to inflict a harm that is foreseen, but in no way unintended or desired. In the paper, ‘The Problem of Abortion and the Doctrine of Double Effect’, Philipa Foot outlines two ways in which harm may be classified as intentional. According to Foot, harm is intentional if it is aimed as an end, in which harm is the intended goal, or if it is used as a means to an end, in which people are harmed in the process of achieving a goal (Foot, p.
The DDA is another, distinct, set of ethical principles, which predicate the moral distinction between doing versus allowing harm. Specifically, the DDA states that it is morally worse to harm someone than it is to allow them to be harmed. As Foot states, there are two ways in which we can allow someone to be harmed. Firstly, one can fail to prevent another from incurring harm, and secondly, one can remove a barrier that was preventing harm (Foot, p. 6).
The DDE and DDA can be applied to various scenarios to determine the permissibility of one’s actions when harm will be bestowed upon another individual. One such example is the hypothetical case of the ‘violinist’, presented by Judith Thomson in her paper ‘A Defense of Abortion’. As Thomson outlines in her example, a famous and unconscious violinist is found to have a fatal kidney illness. In an attempt to save the violinist, the Society of Music Lovers has scanned all medical records and determined that you are the only individual with the correct blood type to provide aid. Therefore, they kidnap you and while you are unconscious, they connect your circulatory system to that of the violinist so that his toxins may be filtered out by your kidneys. Upon waking up in the hospital, the doctors inform you, that unplugging the violinist will certainly kill him and to properly cure his illness you must remain connected for 9 months upon which he could be safely removed (Thomson, p. 48-49).
Both the DDE and DDA provide insight into the permissibility of unplugging oneself from the violinist when this action will inevitably result in his death. In the case of the DDE, the act of unplugging oneself would be viewed as the intended goal and the subsequent death of the violinist would be viewed as a foreseeable but unintended harm. Therefore, in light of the DDE, unplugging oneself from the violinist would be deemed permissible. The DDA would also consider the act of unplugging one-self as morally permissible, as removing one-self from the violinist, would be removing a barrier preventing harm (Foot, p. 6) and subsequently allowing the violinist to die as consequence of his original illness. Therefore, by unplugging the violinist one is allowing him to succumb to harm rather than directly causing it.
In a variant case of the ‘violinist’, all aspects of the Thomson’s case remain the same, however, to disconnect oneself from the violinist, one must now slit his throat. The DDE and DDA can once again be applied to address the permissibility of unplugging oneself in this variant case. In contrast to Thomson’s case, the DDE and DDA would both classify the act of unplugging oneself by slitting the violinist’s throat as impermissible. In the case of the DDE, slitting the violinist throat would be viewed as an intentional harm, as this action would be intended as a means of unplugging oneself. As for the DDA, unplugging oneself by slitting the violinist’s throat would be viewed as directly killing rather than allowing to die. Therefore the intention and contribution one makes in the violinist’s death by slitting his throat is impermissible in light of the two doctrines.
The applicability of DDE and DDA can be extended to the parallel topic of abortion if one grants the fetus the same moral status as a person. Foot does this in her paper, ‘The Problem of Abortion and the Doctrine of Double Effect’, where she discusses 2 procedures through which abortions can be accomplished. The first method of abortion outlined, is a hysterectomy, whereby the mother’s uterus is removed with the fetus inside. According to the DDE, performing a hysterectomy would be permissible as the intended action is the removal of the mother’s uterus and the subsequent death of the fetus is a foreseeable but unintended harm of performing the surgery. The DDA would also classify performing a hysterectomy as permissible as the fetus’s death would be viewed as a case of allowing to die due to the removal of a a barrier that was providing it sustenance.
To contrast this case, Foot then presents a second case of abortion called a craniotomy, whereby the fetus’s skull must be crushed in order to save its mother’s life during labor. In this case, Foot points out that the DDE would not condone this procedure and that the permissible course of action would be to allow the mother to die. This is because; in not performing the procedure we foresee the mother’s death but in no way intend or desire it, whereas directly crushing the fetus’s skull would be considered an intentional cause of its death. Similarly, the DDA would also classify craniotomy as impermissible as crushing the fetus’s skull would be considered a direct action of killing rather than allowing death to occur.
From the above examples, it is evident that using the DDE and DDA to assess the permissibility of abortion is heavily stringent upon the procedure through which abortion is performed. This sets up a moral hierarchy whereby allowing death, as in the case of a hysterectomy, is seen as morally superior to directly killing, as in the case of craniotomy. While it appears intuitive that there are differences in the permissibility of allowing one to die and directly killing, Frances Kamm demonstrates that in the case of abortion, allowing to die and killing may be viewed as morally equivalent. For this reason, using the DDE and DDA to determine the permissibility of abortion is not satisfactory. I will now outline Kamm’s solution and subsequently demonstrate how it is used to achieve the conclusion that abortion is permissible.
Relating to the mother-fetus relationship, it is well established that the fetus is dependent on its mother’s body for its survival. Kamm’s first argument is based on the premise that need alone does not confer a right for the fetus to have aid. As Kamm elaborates, ‘The efforts required in even a normal pregnancy, labor, and delivery are strenuous and risky, not merely inconvenient, and so they extend beyond what a woman is obligated to provide merely because it will save a fetus’s life’ (Kamm, p. 10).
Although one could argue that the mother has a special obligation to aid the fetus as she created the fetus and thus had a part in producing its need for her body, Kamm’s second argument states that a woman has no special obligation to render or continue supporting the fetus even if pregnancy was a foreseen consequence of her actions. As Kamm states, ‘intentionally and voluntarily creating a fetus let alone unintentionally becoming pregnant as a result of a voluntary act or of being raped does not by itself commit a woman to begin or to continue her support of the fetus.’ (Kamm, p. 11). Analogously, Kamm points out, if one invites a visitor into their house, the guest does not have a right to stay longer than the host wants him to or simply because the host brought him in. Taken together, these examples provide evidence that the mother does not have any special obligation to aid or continue aiding the fetus during pregnancy.
While Kamm argues that a fetus does not have a right to its mother’s body and a mother does not have a special obligation to provide support, one could argue that since the fetus is a person, it has a right to life and the negative right not to be harmed. To address this counterargument, Kamm first points out that harm must be gauged from a baseline, which in the case of abortion must represent the pre-conceived state and not the state of continued support since the fetus did not have a right to support in the first place. This forms the basis of Kamm’s third argument, ‘The fetus is not harmed relative to its pre-attachment prospects (and it is not worse off than it would have been if it had never been in the woman’s body)’, and thus, ‘Killing the fetus does not cause it to lose anything that the woman is morally responsible for its having and that it could retain independently of her’ (Kamm, p. 12). Taken together, this appears to demonstrate that abortion does not harm or forfeit the fetus’s its right to life, as it is not harmed or deprived of anything beyond what the mother is continuously providing and which she has no obligation to support in the first place.
Using the above arguments Kamm attempts to demonstrate that allowing to die and directly killing are morally equivalent in the case of abortion. Specifically she emphasizes that ‘If we let someone die, that person loses only what he would have had as a result of our help at that time; by contrast, when we actively kill someone he often loses what he would have had independently of us at that time’ (Kamm, p. 7). In the case of abortion, irrespective of the procedure performed, the fetus only loses what it had as a result of its mothers’ help during pregnancy. This appears to parallel the case of allowing to die and therefore suggests that abortion must be permissible irrespective of the method through which the procedure is performed. This counters the principles set forth by DDE and DDA and demonstrates that these doctrines cannot satisfactorily be applied to cases of abortion.